Provider Demographics
NPI:1710070347
Name:GADALETA, DOMINICK (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:
Last Name:GADALETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 EAST SHORE ROAD
Mailing Address - Street 2:SUIITE 203
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023
Mailing Address - Country:US
Mailing Address - Phone:516-482-8657
Mailing Address - Fax:516-829-0002
Practice Address - Street 1:310 EAST SHORE ROAD
Practice Address - Street 2:SUIITE 203
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023
Practice Address - Country:US
Practice Address - Phone:516-482-8657
Practice Address - Fax:516-829-0002
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171270208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OO1871Medicare ID - Type Unspecified
F40945Medicare UPIN